I'm Pregnant, Now What?

A step by step guide on accessing maternity care in Brisbane

You have just done a home pregnancy test and it's positive and you aren't sure what to do? I get it, navigating healthcare can be incredibly confusing. As a midwife with 10 years experience, this blog post is here to help guide you through the process of accessing maternity care.

In QLD, there are multiple options for maternity care, Public Hospital, Public Birth Centre, Private Obstetric & Private Midwifery care (see below for a list of model of care options). Private midwifery care can be accessed without a gp referral, and as private midwives often fill their books quite quickly, it is recommended to reach out as soon as you take a home pregnancy test. Private midwives are able to organise blood tests & ultrasounds without a doctor, with eligible private practice midwives having access to facilitate hospital births.

If you are not interested in a private midwife or can't afford their care, your first step will be to book in a gp appointment. This will be your first touch point during pregnancy, and your gp is who can make a referral to a public hospital or private obstetrician. At your first gp appointment, they will talk you through your options in regards to continuing your pregnancy and tests and model of care. Your GP will send you for a blood test called a HCG as well as a routine antenatal blood screen and give you a referral for an early dating ultrasound scan.

If you are interested in a midwifery group practice or birth centre, it is important you tell your gp to send this on the referral ASAP. The hospital in your area will require a HCG or ultrasound to confirm your booking, but please let your gp know not to wait until 12 weeks to send the referral or you may miss out on these models of care which are extremely limited in QLD.

If you opt yo use a private obstetrician for your pregnancy care, your gp will be able to offer recomendations for Obstetricians in your area and the hospitals they work at. You will require private health for this, and still may be out of pocket for your care.

Timeline of early antenatal care

One: Take home pregnancy test

Two: Visit Gp or contact private midwives in your area

Three: Have blood tests & dating scan

Four: See GP for results, have GP make referral ASAP and include model of care. Gp will discuss 12 week ultrasound & NIPT (both are early screening tests for some genetic conditions)

Five: Have screening tests if you wish to.

Six: See GP for results & get referral for 20 week ultrasound (morphology)

Seven: Book into model of care if you haven't already! If you haven't heard baby's heart beat yet, this will be the first time you will hear the most beautiful noise you have ever heard <3 Don't forget to record it!

Below is a list of models of antenatal care and what they do...

Private Midwife: Private midwives work either solo or in a practice. Private midwives can facilitate home births as well as some having rights to care for their women within a hospital. It is still recomend to book in with your local hospital should you require transfer. Private midwives can cost $3000 upward, but they offer continuity of the antenatal, intrapartum and postpartum period (up to 6 weeks). Private midwives can order routine blood tests and ultrasounds, as well as prescribe medications. Private midwives work under the consultation guidelines, and are collaboritive practitioners that will work with obstetricians should you require extra care.

Private Obstetrician: Private obstetricians are sole care providers that care for you during your antenatal period, are there at the birth & do some postnatal follow up. They can facilitate births at hosptials they are associated with. You do require private health if you wish to birth with your obstetrician, as the fees can be quite costly. Some women opt to do only antenatal and postnatal care and birth in a public hospital instead.

Gp Shared Care: Gp shared care is a model of care within a public hospital for women experiencing low risk pregnancies. Your gp will provide most of your pregnancy care, with some antenatal appointments at the hospital with a midwife and/or obstetrician. Not all gp's provide or are confident in antenatal care and education, if you opt for gp shared care or don't get a place in a midwifery lead model of care, I recomend ensuring your Gp is experienced and confident in providing care and education. Your gp should be checking and ordering tests and ultrasounds, checking baby's position, measuring your uterus & listening to your baby at each antenatal appointment. With gp shared care, you will have a midwife or obstetrician working within the hospital look after you in labour and postnatally you will have limited home visits from the hospital. You will need to seek outside resources to educate yourself on labour, birth & the postnatal period.

Midwifery Teams (not MGP): Midwifery teams are a group of midwives that offer antenatal care. Some teams will also work in birthsuite, however you won't have one named midwife. Some teams may do limited postnatal follow up. The teams work with a similar philosphy and offer education throughout your pregnancy. Midwives within these teams will liase with obstetricians if required and refer if needed.

Midwifery Group Practice (MGP): MGP is a small group of midwives that offer continuity of midwifery care throughout the antenatal, intrapartum & postnatal period (up to 6 weeks). These positions are highly sought after and extremely limited within the public health system, it is important to be referred ASAP to be considered for one of these positions. MGP midwives work closely with obstetricians if required. Some MGP's are an all risk model of care, caring for women with co morbidities and twins!

Birth Centre: Some QLD hospitals offer birth centre model of care. The birth centres may run their models slightly differently, with some offering one named midwife and some working within a group model; however, their philosphy is always the same. The birth centre will only take on women with low risk pregnancies who do not want any intervention in their labour and birth. The birth centre is a great option for women who may not be able to afford a home birth or don't feel comfortable birthing at home. Birth centres have birth tubs and are fully equipped, however have a more "homely" feel. The birth centre is also highly sought after, with only limited amounts of women being accepted into this model of care. Ensure your gp refers you ASAP to be considered for a position within birth centre.

Tertiary: This model of care is obstetrician led for women who have have co morbidities or complex pregnancies. You will still see a midwife in your pregnancy for education, however the obstetricians will lead your care, possibly with other teams who may be involved due to complex medical or fetal issues.

Indigenous Care Models: These models of care is available in most hospitals, however may look different between hospital to hospital. If you or your partner identify as Indigenous, these programs offer culturally appropriate care through the antenatal, intrapartum & postnatal period. You will be linked in with Indigenous liasion workers and other community supports to help you navigate the system. Please ensure your gp adds this to your referral.

Please remember that this is YOUR pregnancy and no one elses. You need to feel confident and educated as well as held and supported by your care provider. If you feel like something isn't a right fit or doesn't sound right, question it.